Florida YIG: Chapter Intent to Participate Form
Planning on participating this year? Please let us know some information about you and your group, so that we can follow-up with you.

Please submit one entry for EACH High School or Middle School Chapter, no later than the first Wednesday in October.

Program Year *
Please select the current Program Year
Chapter Information
High School or Middle School Chapter *
Who will your Chapter serve?
Delegation Name *
If your delegation name isn't listed, please contact registration@floridayig.net
YMCA or School Based? *
Is your Chapter YMCA or School Based?
Estimated Number of Members *
How many registered members do you think your Chapter will have during this Program Year?
Your answer
Estimated Number of FDC Attendees *
How many members (Sr. YIG) do you estimate this Chapter will send to Fall Delegate Convention (FDC) this Program Year?
Your answer
Estimated Number of State Assembly Attendees *
How many members (Sr. YIG) do you estimate this Chapter will send to State Assembly this Program Year?
Your answer
Estimated Number of Jr. Assembly Attendees *
How many members (Jr. YIG) do you estimate this Chapter will send to Jr. Assembly this Program Year?
Your answer
Chapter's Host YMCA/School/Organization
Name of Host YMCA/School/Orgainzation *
Name of the YMCA/School/Organization that hosts your program.
Your answer
YMCA/School/Organization Address *
Street Address
Your answer
YMCA/School/Organization Address *
City
Your answer
YMCA/School/Organization Address *
Zip Code
Your answer
Lead Chapter Advisor
Lead Chapter Advisor: First Name *
First Name of Chapter's Lead Advisor
Your answer
Lead Chapter Advisor: Last Name *
Last Name of Chapter's Lead Advisor
Your answer
Lead Chapter Advisor: E-mail address *
Your answer
Additional Advisor Information
Please list any additional advisors who you would like to have updates sent to - (First & Last Name, Email Address)
Your answer
School Administrator (for School Based Chapters ONLY)
School Administrator: First Name *
If School Based - Name of Administrator who has given approval for Chapter to exist on campus
Your answer
School Administrator: Last Name *
If School Based - Name of Administrator who has given approval for Chapter to exist on campus
Your answer
School Administrator: Email address *
If School Based - Email Address of Administrator who has given approval for Chapter to exist on campus
Your answer
Local YMCA Branch Contact
Local YMCA Branch Contact: First Name *
First Name of your local YMCA Branch Contact
Your answer
Local YMCA Branch Contact: Last Name *
Last Name of your local YMCA Branch Contact
Your answer
Local YMCA Contact: E-mail address *
Your answer
Chapter President
Chapter President: First Name *
First Name of Chapter President
Your answer
Chapter President: Last Name *
Last Name of Chapter President
Your answer
Chapter President: E-mail address *
Your answer
We the Student Leadership & Adult Advisors of our Chapter knowledge that:
Please check the boxes below to signify your understanding and compliance with the following statements: *
Required
We agree to: *
Required
Chapter Name *
The name of your Chapter as recognized by the State Office
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This form was created inside of Florida YMCA Youth In Government.